Stress management is a phrase I’m sure you have all heard before but may not have realised its significance to your health. When approaching health holistically, managing stress is vital in the proper treatment and management of your digestive health concerns.

To help further the work you are doing to help your digestion and honour the investment you have made in testing and treatments, I want to share with you the importance of bettering your mental and emotional well being.

What is stress?

Stress is anything that is a threat to staying in balance (homeostasis). A threat can be real (i.e. physical stress including temperature change, trauma from a car accident or breaking a bone) or perceived (i.e. psychological stress such as relationship issues, running late and feeling busy). Stress causes our body to carry out a response that helps with adaptation and survival. However frequent, chronic or excessive stress may lead to disease (1,2).

Your nervous system

The autonomic nervous system (ANS) is part of your nervous system that controls muscles of internal organs (such as the heart) and glands on an automatic level (that is, we don’t have to tell them to work). Two significant parts of this system include:

Sympathetic nervous system, which prepares your body for physical and mental activity. It makes your heart beat faster and stronger, opens your airways so you can breathe more easily, and inhibits digestion. This is also the nervous system we fall into when we are in a state of stress, anxiety, fear or overwhelm.

Parasympathetic nervous system is responsible for bodily functions when we are at rest (sleep, meditation etc.) It stimulates digestion, increases digestive juices, relaxes muscles in the gastrointestinal tract, activates various metabolic processes and helps us to relax (3).

Mind-Gut connection

Your enteric nervous system (the nervous system in your gut) is also part of the ANS and is connected to the central nervous system (brain and spinal cord) by the sympathetic and the parasympathetic pathways, forming the brain–gut axis (1,4).

How stress may be impacting your gut health

Feeling of stress, anxiety, overwhelm and worry mean that our bodies’ are working in a sympathetic state (fight and flight) rather parasympathetic state (rest and digest). When these feelings are in excess it may not just be your mind that suffers, but also your gut.

1. Dysbiosis (imbalance of bacteria)

There are several ways by which stress can alter your bacteria, including changes in gut cell function, mucus secretion and changes to digestive muscle contractions. Noradrenaline, a neurotransmitter secreted in stress, has been shown to stimulate the growth of pathogenic ‘bad’ and non-pathogenic ‘good’ Escherichia coli and influences their adherence to the gut wall (5).

2. Gastroesophageal Reflux Disease (GORD)

It is not completely understood, but a change breathing (which occurs when we are stressed) may contribute to GORD by altering the valve between the stomach and the oesophagus, increasing oesophageal sensitivity, and slow stomach emptying (1).

3. Dyspepsia (Indigestion)

People with indigestion experience a poor stomach response to meals (due to lack of enzymes and secretions), post-meal discomfort, prolonged feeling of fullness and an increase in intestinal muscle contractions. These unideal digestive changes have been linked to signals received from the sympathetic nervous system (1).

4. Inflammatory Bowel Disease (IBD)

Imbalance between the sympathetic and parasympathetic has been reported in patients with IBD. For example, depression has been connected with Crohn's Disease and stress in Ulcerative Colitis. Animal studies show that stress exacerbates colitis and that depression increases susceptibility to inflammatory triggers (1, 5).

5. Irritable Bowel Syndrome (IBS)

Stress is factor known to predispose individuals to IBS and is also known to alter the bacterial composition. Patients with IBS have an increased response to stress, and stress is also a predictor of IBS as well as a determinant of symptom severity (5).

6. Intestinal permeability ‘Leaky gut’

Psychological stressor increases small intestinal permeability. Hormones secreted in a state of stress influence different receptors and immune responses and can cause changes to the gut barrier and function(6).

There are endless ways you can start to manage stress, anxiety and overwhelm in your life. These include breathing exercises, music, meditation and exercise - countless phone apps can support these practices. Explore, find what works for you and make a regular practice of it.

What does the gut have to do with thyroid function? We see many patients with low thyroid function and autoimmune thyroid conditions. As a gut-health specialist clinic we will of course ask about your gut – but particularly so when we hear anything related to the thyroid or thyroid-associated symptoms. Why?

The gut and the thyroid are intimately linked and influence each other in many ways. Essentially – poor gut health suppresses thyroid function and low thyroid function causes inflammation and may contribute to leaky gut.

There is a myriad of contributing factors to gut-thyroid imbalances, such as stress and cortisol release which increase intestinal inflammation and permeability; and sluggish digestion and constipation, gallbladder issues and low stomach acid which can be caused by low thyroid function. However today I will go into a bit of detail about the two important mechanisms that link the thyroid and the gut: GALT and the MICROBIOME.

*Note: the subject is huge one and this blog is by no means an exhaustive explanation of all links.

GALT Tissue

Ever hear the statistic that 70-80% of the immune system, or rather immune tissue lies in the gut?1 It’s true. I’ll explain…

Apart from digestion – the most important function of the gut is to protect us from the unwanted microorganisms that we ingest when we eat, drink and breathe. The digestive tract runs from mouth to anus and if you think about it, this tract is essentially a hollow tube that is open to the outside world. This means we need a strong barrier and good soldiers to protect our bodies from the barrage of potential invaders every time we eat, drink, breath, kiss – you get the picture.

The body has an ingenious method of protection- its all about the GALT…GALT stands for Gut Associated Lymphoid Tissue2. The digestive tract is lined with vast amounts of this GALT – immune tissue and is comprised of immune cells such as B and T lymphocytes – the soldiers of the immune system. Due to the large amounts of GALT in the gut – any issues in the gut will have a profound effect on the body’s immune system as a whole.

Problems in the immune system occur when this barrier containing immune cells becomes damaged due to various causes such as stress, environmental toxins, low thyroid function and diet – this is called Leaky Gut or Intestinal Permeability.

When the gut lining is damaged it becomes inflamed and as a result larger particles from our food are able to pass through the inflamed gut tissue into our blood stream. This is not normal and the soldiers in our immune system get confused and mount an attack/response in order to protect us. A case of mistaken identity. This causes a massive amount of systemic inflammation and tissue destruction. This ‘hyped up’ immune system plays a key role in the development of autoimmune disorders such as Hashimoto’s - see more info about how to treat leaky gut HERE.

The Microbiome

A little known fact is that good bacteria in your gut help to convert inactive thyroid hormone (T4) to the active from (T3) – by producing the enzyme intestinal sulfatase. This enzyme is necessary for this conversion to take place. Some studies suggest about 20% of thyroid hormone is converted in the digestive tract this way. That’s huge!

This illustrates how important it is to have healthy populations of good gut flora in order to support your thyroid, and is commonly why people with compromised gut function also have thyroid symptoms. Additionally diverse populations of gut flora are essential for good gut-barrier function and healthy GALT tissue, and protect against leaky gut and pathogenic microorganisms.

Naturopathically, we say that everything in the body is linked and we like to look at the whole picture. When treating conditions such as Hashimotos we will always look at diet, environment, emotions, stress, sleep and any other factors that may be compromising your thyroid health – and of course address any underlying gut issues.

When twenty-six year old Jen first visited Narayani Wellness Medical 8 months ago she felt constantly fatigued and unwell. Most mornings she would rise feeling like she hadn’t slept a wink, despite sleeping a solid 7-8 hours each night. She would wake with what she described as “brain fog” - a mild headache alongside difficulty concentrating, finding words and performing basic mental tasks. Jen likened many of her symptoms to a hang over, recalling a gradual worsening since high school.

Tiny, itchy, fluid-filled blisters had begun to appear on her hands and the skin on her face was flushed and dry. She has always had sensitive skin, though these skin issues only arose in the last few years. She also complained of terrible hay fever in spring and autumn, which she experienced every year for as long as she could remember.

Jen couldn’t understand why she got these debilitating symptoms despite her healthy diet and adequate sleep. She had been to see a couple of GPs who ran some tests, all of which came back normal (besides a mild deficiency in iron). Jen was given a script for an iron supplement, anti-histamines for the hay fever and a steroid cream for the blisters on her hands. Despite these interventions, Jen’s symptoms did not improve.

By this stage, Jen had begun feeling very despondent about her health, questioning whether she would be able to finish her university course and start full time work feeling this way. After reading a blog on gut health that was sent to her by a friend, Jen came to the clinic to learn how her symptoms might relate to her gut i.e. her small and large intestine.

What could be affecting Jen?

After some thorough questioning, we suspected that Jen’s issues related to non-coeliac gluten sensitivity. We performed an intestinal permeability test on Jen – a urine test that uses two sugars, lactulose and mannitol, to determine if the gut is “leaky”. Her result was positive, indicating that her gut lining was allowing trigger compounds (e.g. food proteins and toxins from bacteria) to slip through into her bloodstream. Resultantly, her immune system was hyperactive, accounting for her inflammatory skin issues and lack of mental clarity.

We also screened her for intestinal parasites, small intestinal bacterial overgrowth (SIBO) and low stomach acid, some of the most common contributing factors to leaky gut. Her nutritional status was assessed, finding that in addition to iron, she was also low in zinc, vitamin D and omega-3.

We spoke to Jen about her relationship with stress, discovering that she had perfectionist tendencies. She often put a lot of pressure on herself to have all the answers, blaming herself for her poor health. She also liked to perform to a high standard, making even small tasks stressful. Jen didn’t recognise that her day-to-day stressors were affecting her; yet it was having a direct effect on intestinal permeability via her enteric nervous system (the part of the nervous system that intertwines the intestines).

What was suggested to Jen?

We suggested Jen completely remove gluten from her diet for a period of time and recommended some supplements to heal her gut lining – zinc, glutamine, probiotics, prebiotics and good fats. We worked with Jen to reduce her stress levels by combining psychological interventions, breathing techniques, meditation, exercise and all-round better self-care.

We explained that you aren’t necessarily what you eat, but what you absorb. Our goal was to improve her intestinal function first by addressing the underlying issues (in her case; gluten, stress and zinc deficiency) and then to ensure her nutritional status was optimised and maintained with supplementation and diet.

Jen’s progress

Jen’s mental clarity and energy levels had improved so much within 1 month of removing gluten that she decided to continue eating this way indefinitely. After 2 months of treatments her skin started to settle, and after 6 months her skin was better than it had ever been. The next spring she didn’t need to use anti-histamines at all. Jen is now much better at recognising when she is stressed, so she can manage it before it interferes with her health.

With a few simple changes in Jen’s day-to-day diet and lifestyle, she has seen massive improvements to her health. Jen’s story is a fairly common one, however treatment for leaky gut is not one-size fits all. Each case requires tailored treatments that address the underlying factors unique to the individual.

Due to the abundance of information available and our habit of asking Dr Google for answers, there is a lot of confusion around gluten and if it is ‘good’ or ‘bad’ for you. I’d like to give you some evidence-based information that may help you decide the role of gluten in your diet by answering five of the most frequently asked questions I receive.

1. What is gluten and where is it found?

Gluten is a structure that is made up of hundreds of proteins, notably gliadin and glutenin, and is found in grains like barley, durum, semolina, wheat, farina, kamut, rye and spelt grains(1). Many of these grains are used to make breads, pasta, cakes, pastries, and biscuits to give them their fluffy or stretchy texture. Gluten is used as an additive in processed foods to improve texture, flavour and moisture retention. Some foods where gluten may be hiding include vegetarian meat substitutes, confectionary, ice -cream, butter, seasonings, sauces, marinades and dressings(2). All in all, gluten plays a large role in the standard Australia diet and is delicious!

Coeliac disease (CD) is an autoimmune disease in genetically susceptible individuals that is caused by eating gluten(3). Classic symptoms include diarrhoea and failure to thrive within the first couple of years of life. You may experience other symptoms or no symptoms at all and can still have CD. CD is diagnosed through a biopsy of the small intestine but may be detected in blood tests that look for specific immune markers(4).

Non-coeliac Gluten sensitivity (NCGS) occurs in people who are not affected by CD or a wheat allergy. The biggest difference between NCGS and CD is that there is a different immune response to gluten and there isn't the complete destruction of your gut villi (finger like projections important for nutrient absorption)(5,6). NCGS symptoms occur hours to days after eating gluten and can disappear when gluten is removed. Classic symptoms include abdominal pain, bloating, bowel habit abnormalities, foggy head, headache, fatigue, joint and muscle pain, dermatitis, depression and anaemia(7). Clinically we see increased intestinal permeability aka ‘leaky gut’ confirmed on blood or urine testing underlying NCGS.

3.Does gluten cause leaky gut?

In short, yes.

In susceptible individuals, when you eat gluten, the tight junctions (gate-like structures in your gut wall) are told to open-up as a result of an increased release of zonulin. Zonulin acts as a signal that says ‘open up please!’ to your gut wall. When gluten is removed from the diet, zonulin levels decrease which causes the immune system to calm down and healing to begin. It’s very important when healing leaky gut to follow a strict gluten-free diet, as the smallest amount of gluten will trigger a zonulin release(8).

4. What are some gluten-free alternatives?

There are many grains that are gluten-free including amaranth, buckwheat, corn, millet, quinoa, rice, sesame, sorghum and teff. Products like arrowroot, lentils, rice and tapioca can produce gluten-free flour and thus to some extent replace wheat flour(1). Luckily in 2018 there is much more awareness around the need, desire or demand for gluten-free products so there are many delicious alternatives available. It is worth noting that there is great variation the quality of the gluten-free alternatives in regards to nutrient, protein and fat content and glycaemic index (how much they impact your blood sugar levels)(9). My advice is to go wholegrain where you can or at the very least, have them with nutrient dense, protein and fat rich toppings, fillings or sauces.

5.What about oats are they gluten free and can I have them?

Gluten is a complex mixture of hundreds of proteins (called prolamins), notably gliadin and glutenin. Similar prolamins exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as “gluten”(10).

Avenin in oats contain a smaller amount of an amino acid called proline, which is higher in some of the other proteins mentioned in wheat, barly and rye. Lower proline content may be why oats are less immune reactive compared to wheat, but may still be a problem in large quantities. Oats may still activate specific immune cells in 10% of CD patients so it may be wise to avoid oats as part of your gluten free diet (11).

Furthermore, it is common for oats to be farmed and milled with wheat and are therefore contaminated with gluten. It is possible that pure, uncontaminated oats, can be made into products that contain less than 20mg of gluten per kg, making it potentially safe in a gluten free diet (12). One commonly recommended brans of gluten-free oats is Bob’s Red Mill.

Final thoughts

There is so much more to be said about gluten and how it may affect your health, so if you still feel unsure about gluten in your diet, please reach out to us at Narayani Wellness to receive some personalised guidance. Our support can help a potentially confusing path be more simple and accurate for you!

We all know that probiotics are great for digestive health, but how do you know which one your gut needs? The bottle lists the various species of bacteria (or yeasts) contained within and offers a vague description of what they do, which really doesn’t give away a lot unless you know what to look for! This article is all about what to look for in a probiotic and in addition, I will dispel some common myths about how they work.

Let’s start basic. What is a probiotic?

The World Health Organisation officially defines a probiotic as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” (1). Probiotics can be bacteria, such as the commonly seen Bifidobacterium or Lactobacillus species, or yeasts such as Saccharomyces boulardii. You will find probiotics in health food stores, chemists and health clinics, sold as capsules or powders, either alive or freeze dried (alive, but sleeping). Proper storage of probiotics is essential in ensuring they are still alive and healthy by the time they reach your gut, so always follow the storage instructions on the bottle and be mindful when transporting your probiotics.

How do probiotics work?

Myth number 1 – probiotics permanently make our gut their new home. It is a common misconception that we take probiotics to replace healthy bacteria that have been lost, for example, following antibiotic treatment or during times of stress. Probiotics work their magic while they are in transit through our gut and are eventually flushed with the stool (2). They may stay in there a bit longer than our food, but it isn’t forever.

Myth number 2 – all types of probiotics fight off bad bugs. Many (not all) probiotics do have the ability to compete with bad bugs and stop them from taking over, however the beneficial action of probiotics goes far beyond (3). Additional examples of how they work includes:

Reducing inflammation in the gut

Speeding up or slowing down the time it takes for food to travel along the digestive tract

Reducing how sensitive our gut is to internal gas

Repair and strengthen the gut lining

Interacting with immune cells (think allergies as well as infections)

Influence intestinal secretions

Why are probiotics named the way they are?

As probiotics are living organisms, they are given latin names just like all plants and animals. In order to differentiate probiotics, you need to understand the terminology around their naming. I will use an example of the probiotic bacteria Lactobacillus rhamnosus GG.

The first word is the genus – Lactobacillus

The second word is the species – rhamnosus

At the end of the latin name is the strain – GG

The strain may be a combination of letters, numbers or both.

How important is the strain?

The strain is very important when it comes to treating a particular complaint or condition. You could compare strains of probiotic to breeds of dog – all dogs are the same species, but they come in a range of shapes, colours and designs. Likewise in probiotic species, different strains can have a different effect in our guts (1). For example, some strains of Escherichia coli cause intestinal or urinary tract infections, whereas the strain Escherichia coli Nissle 1917 is protective against infections (4).

The strain is commonly omitted from probiotic labels and left out of the discussion when talking probiotics. A good quality probiotic will always include the strain, just like a good clinical trial (a human study) will always state which strain has been tested. Unfortunately, many strains that have been studied are not yet available in Australia.

Which probiotic should I take?

If you wish to treat a specific health condition with probiotics, it is best to do your research and find some positive human studies, then use the same strain. It may be more expensive, but at least you can be sure your money is going into something that will work. There are many articles out there on probiotics, particularly in treating digestive, skin and immune issues such as IBS, traveller’s diarrhoea, inflammatory bowel conditions, asthma and eczema(5).

To give you a few examples, Lactobacillus plantarum CJLP133 can reduce the severity of eczema (6). Lactobacillus rhamnosus GG and Bifidobacterium breve Bb99 can increase the eradication rate of Helicobacter pylori, an infection that causes stomach ulcers (7). At Narayani Wellness, we use Bifidobacteria lactis HN019 to treat SIBO, just one of the probiotics that we keep in our supplement toolbox.

If you are healthy and just looking for a probiotic to support general health, my recommendation is to get stuck into some fermented foods, such as yoghurt, kimchi, sauerkraut, kefir or kombucha. Strictly speaking, fermented foods are not considered a probiotic as the exact microorganisms are typically not known, nor can they be measured. However fermented foods that have been stored correctly are considered safe and beneficial to consume as they increase overall diversity in the gut when consumed regularly, which has been linked to a lower incidence of disease (5). Fermented foods also contain compounds that help to break down your food and keep your digestion working optimally.

If you are still unsure, take the hard work out of your shopping and make an appointment with us today to help find the right probiotic for you.

Since my previous blog about IBS and SIBO I have had so many questions from my patients wanting to know more about SIBO. What stands out to me the most is a confusion around what to eat, with the most common questions surrounding prebiotic, fibre rich foods and if they help or hinder SIBO.

What is a prebiotic food and what does our gut do to it?

A prebiotic is a non-digestible food ingredient that it is not broken down or absorbed in the higher parts of our gastrointestinal tract(1). There are a lot of foods with prebiotic properties including chickpeas, legumes, leeks, rye bread, garlic and cashews(2). They play a special role in our health - they act as food to our gut's good bacteria, increasing their numbers (lactobacilli and bifidobacteria(3)) and improving our overall health(1).

Why do these healthy foods cause discomfort?

In SIBO, the overgrowth of bacteria causes inflammation and hurts your gut wall affecting your ability to breakdown and digest food. The bugs themselves play havoc with your own enzymes and body processes. For example there is loss/decrease in an enzyme called disaccharideses, which is important for breaking down carbohydrates and sugars. This means that any food, like a prebiotic food that contains fructose, lactose and sorbitol, may not be digested properly, resulting in those uncomfortable symptoms you experience(4).

Treating SIBO… with prebiotics?!

You may notice that some of the foods that cause your discomfort are also considered to be high FODMAP foods. FODMAP describes a group of of short-chain carbohydrates and sugar alcohols comprising of fructose, lactose, fructo- and galactooligosaccharides (fructans, and galactans), and polyols(5).

To provide symptom relief from SIBO we may suggest avoiding these high FODMAP prebiotics foods (looking at you apples, onions and garlic!) for a short period of time. It is really important to know that excluding these foods long term is not the answer and will not fix SIBO(6). A healthy gut is dependant on you eating a fibre rich, highly diversified diet so restricting these foods for a long period of time will only worsen your situation and increase your sensitivity to more foods(7). It's not uncommon that we see patients tolerating only a handful of foods and it's best to avoid this!

Garlic, a wonderful prebiotic food.

As part of our treatment for SIBO we use certain types of prebiotics in combination with probiotics and specific antimicrobials (bug killers). These types of prebiotics have beneficial roles in our gut health that are important for restoring your gut health.

The following are four common prebiotic supplements on the market, three of which we use regularly in the treatment of SIBO. The fourth is not advised!

1. Lactulose

Lactulose is made up of two sugars, galactose and fructose, which is not broken down or absorbed in our small intestine. Lactulose increases our good bugs like bifidobacteria(8) and decreases the bad ones like clostridia(9). It is generally well tolerated, however you can take too much of it and end up with loose bowels(8).

2. Partically Hydrolysed Guar Gum (PHGG)

PHGG is a natural water soluble fibre that has been broken down by an enzyme to make it smaller and to decrease the amount of galactomannon (10). PHGG increases the good bugs Bifidobacterium and Lactobacillus species and decreases nasty waste products such as ammonia(11). PHGG can also give softer stools to assist constipation(12). Studies also show that PHGG in combination with an antibiotic to treat SIBO was more useful in eradicating SIBO compared with the antibiotics alone(13), how amazing!

3. Galacto-oligosaccarrides (GOS)

GOS is formed by breaking down lactose, a common sugar found in dairy. GOS is known to increase the good bugs bifidobacteria and reduce the bad bugs, clostridia and bacteroides. Another benefit of GOS alone or in combination with a probiotic is that it can support our immune system. GOS used in its recommended dosage range is well tolerated. Again, too much of a good thing can lead to problems; abdominal discomfort, cramping, flatulence and diarrhoea(14).

4. Inulin

Inulin is beneficial to out gut because it supports our good bugs bifidobacteria. However, because it is made up fructans(15), it can be really uncomfortable to consume if you have SIBO. Studies have found inulin increases flatulence, rumbling, stomach and gut cramps, and bloating(16). So best to avoid this one!

Take home messages

Prebiotics are very powerful and beneficial for SIBO. But remember, not all prebiotics are the same.

If certain foods are causing you pain, bloating, constipation, or diarrhoea, this is your body communicating to you that your digestion system is struggling. Ironically the foods that cause discomfort are the same foods that are important to your health. Instead of excluding these foods, we need to improve your digestive system so you can tolerate these and improve your health in the long run. This can be impossible to navigate by yourself so get a professional on board to help correct your bugs, restore your gut wall and find the diet and fibre that is right for you.

After this, you may even be able to handle eating delicious lentils, onion, garlic and apples!

The exciting possibilities of prebiotics for a variety of digestive, immune and mood related complaints are only just being discovered. Prebiotics are receiving more attention with the increasing understanding of the human microbiota (all of the bacteria, viruses and fungi that live on and in us), as the two together can have an incredible impact on our health.

What are prebiotics?

Essentially, prebiotics are ingredients found in whole, unprocessed vegetables, fruits, legumes, grains, nuts and seeds which are not digestible to us, but provide the perfect food for beneficial gut bugs living within us(1). These ingredients are broken down by the microorganisms in the digestive tract into compounds that have a beneficial effect in multiple areas of the human body, which can include altering the activity of the same bugs that created them! Most prebiotics are carbohydrate fibres, and it’s the knock-on effect of eating them that makes them so special.

How do they relate to probiotics?

I often hear prebiotics being confused with probiotics. While they act very similarly in the gut, they are in fact different. Probiotics are live organisms that we take in supplement form, where the species of bacteria are known and measured(2) Much like the gut bugs that have been living in us since the first few days of life (our microbiota), probiotics also love to munch on prebiotics. You will often find probiotics and prebiotics in combination in a supplement to enhance the products therapeutic quality. A lot of the research around prebiotics looks at how they interact with two of the most common probiotics, Lactobacilli and Bifidobacteria(3).

What’s the difference between fibre and prebiotics?

Most prebiotics are fibre, however not all fibres are prebiotic. Fibre is often classified as insoluble or soluble, which also provides a good basis for distinguishing which ones are prebiotic.

Insoluble fibres do not get broken down by us or by our gut bugs, however they do bulk out the stool, helping to keep us regular(4). These are the stringy fibres that give a lot of foods their rough texture, such as the skin of nuts, seeds, fruits and vegetables.

Soluble fibre, found in a variety of whole foods, cannot be broken down by us, but are easily fermented by bacteria. Those that exert a proven beneficial effect on us are termed prebiotics.

Types of prebiotics

Here is a little bit of extra information for the science lovers out there. A clear cut catagorisation of what is and what isn’t a prebiotic has not yet been established as it is still a young area of science. If we consider what has the potential for prebiotic activity, the following fibres and their respective foods are included:

Resistant starch, which is starch that resists digestion in the small intestine, making it available in the large intestine for fermentation (potatoes, legumes, whole grains).

How do prebiotics improve our health?

Prebiotics selectively stimulate the growth of beneficial bacteria that are indigenous to our guts, including the well-studied Bifidobacteria and Lactobacilli species. These bacteria, when thriving, help to seal the barrier between the intestine and bloodstream, improve our immunity and keep potential bad bacteria/fungi (such as clostridia and candida) to a minimum.(3). With a healthy microbiota, improvements are noted in mood, skin, allergies and autoimmune conditions, just to name a few.

In addition, bacteria create short chain fatty acids (e.g. butyrate, propionate and acetate) from prebiotic fibres, which have beneficial effects throughout the body. For example, butyrate, made by Lachnospiraceae and Ruminococcaceae bacteria, is a major energy source for the cells that make up our colon. Propionate acts at the liver to suppress cholesterol synthesis and acetate is utilised by the heart, brain, kidneys and muscles(1).

When prebiotics can be problematic

For people that have certain intestinal issues, such as Small Intestinal Bacterial Overgrowth (SIBO) or Irritable Bowel Syndrome (IBS), eating the wrong types of prebiotics can make symptoms worse. For example, fructans and sugar alcohols (which are both considered FODMAP foods) are known to cause bloating, flatulence and discomfort in certain people(5). However, complete avoidance of prebiotics deprives healthy gut bugs of food and can make the situation worse in the long run. If you fall into the SIBO or IBS, or are unsure, an appointment with us can help minimise symptoms while still making sure your good bugs are fed!

Hi there,I’m excited to announce that we are launching our first ever comprehensive food intolerance & gut healing program to help you, our patients, to truly find the right diet for your unique circumstance.

For some of you green smoothies or blueberry treats, and many other foods that we think are healthy for us, could actually be making things worse.

Spinach, cacao and sweet potato can be causing you to feel lousy.

Confused?Yep. I get it. Up until recently I was too.

Many of you know snippets about my son Jarvis and his health concerns that we’ve been faced with over the past 12 months. It’s been a challenging time for my husband, Jarvis and myself. We have trialed many different diets, spent a lot of money on testing, therapies and supplements, had some wins and made some errors, not to mention had many sleepless nights and invested a tonne of energy to make sense of it all.

But like all good challenges, it has brought forward something truly magical.

This program has come about through my personal experience to help others navigate food chemical sensitivities and healing leaky gut. My aim with this program is that we find what food chemicals may be problematic in a structured way to provide symptom relief and simultaneously focus on our gut bugs & treating the underlying cause.

What is food chemical sensitivity?In our foods there are many natural chemicals that vary in concentration. Some serve to protect the plant against insects and others come about through protein degradation. In many circumstances these chemicals are of benefit – they are antioxidants and act against cancer, inflammation and chronic disease. But for some people, they can reap havoc and be the cause of your symptoms.Think fibromyalgia, chronic fatigue syndrome, migraines, insomnia, depression, anxiety, irritability or skin rashes. Or hay fever, hives, foggy head, weight gain, hair loss… the list goes on!The RPAH elimination diet or FAILsafe diet is a wonderful diet that helps people navigate salicylate and histamine intolerance. You can read more about this on www.fedup.com.auHowever missing from this diet is oxalate intolerance. Oxalates are high in chocolate, nuts, spinach and sweet potato. They are crystals that normally are digested by our gut bugs, but if we have a problem there, they then accumulate and can cause prostatitis, vaginitis, thrush, painful red or itchy bottom, painful sex, Fibromyalgia, CFS and more.

Why not just follow the RPAH elimination diet?This diet gets results for many people. It looks not only at food chemicals but also avoiding preservatives in our foods and other products that may be causing us problems.Yet the suggested foods are high in sugar and well, in my mind, a bit crappy overall.It doesn’t take into account oxalates, the gut microbiome (the world of bacteria) and supplements that can support the food chemical intolerances. It is a case of eliminating the troublesome food, and living this way ongoing.

Why not GAPS diet?Again the GAPs diet has helped countless of people around the world, especially children suffering from behavioural issues.But for us it didn’t work. In the end we were on a gluten free, dairy free, low salicylate, low oxalate, low histamine, low FODMAP, GAPs diet. Which really equates to living on air! And dealing with a huge amount of overwhelm.My experience with the GAPS diet left me asking “what parts of the GAPs diet is beneficial?” Clearly it works and I’ve been sifting through the different principles to see what is essential and what is well, based on a “gut feeling” rather than evidence.

Introducing our program….This program incorporates the RPAH elimination diet, selective principles behind the GAPS diet, and the low oxalate diet.There are three phases to the program:

Preparation (3 weeks)

Elimination (3 weeks)

Challenge (4 weeks)

The preparation phase is essential for the success of the elimination diet. The challenge phase is structured so that you have the best chance of determining what category of foods you are reacting to. It helps us to make sense of what we need to avoid while we are working on the underlying cause, which is where this program leads you.It recognises that whilst we may feel better on a restricted diet, we are at risk of starving our good bugs. For instance, a high fat diet can help us to feel better with less bloating (as our bugs can’t ferment fat) however our good bugs start to decline in numbers and can even become extinct. Once they’re gone it becomes very difficult to re-establish a healthy gut microbiome.This program also challenges many assumptions about gut healing and what foods we should & shouldn’t have, using evidence to back up our recommendations.We hope to identify what your main issues are in relating to food and gut health. Following the program, you then work with our naturopaths or myself to then focus on these, with initiation of specific supplements. It is important to follow these steps to minimise any adverse effects from the treatments. For instance, if you are salicylate intolerant, you cannot tolerate certain herbs and we can modify our approach to better help you.

Who are we looking for?You are motivated and committed to finding answers.You have symptoms (unexplained or listed above) and are concerned they may relate to your diet/gut.You are willing to share this experience with others (small group) in a similar circumstance.You are a type A personality – you like to be on time, thorough with your note taking and following instructions and are reliable.You are happy to share what you learn with us. For instance, we will be providing recipes but hope to get your input in tweaking these or creating something new, so that our resources expand to benefit others.You understand that nothing is guaranteed and take responsibility for your own health. You can attend all sessions - if a class is missed, you are happy to have a quick 1:1 consult with our naturopaths to ‘catch up’.You can afford testing for leaky gut, +/- SIBO +/- stool culture.

A little more detail about the program: We have only 8 spaces available (6 are already filled) and want our first time to be as successful & enjoyable as it can be.Starts: 17th May, runs for 10 weeks (ends 19th July).Time: 0900-1100 every Wednesday morning.It will be run by myself and you will also have the support of Rachel and Lucy (my naturopaths)Each structured session will allow us to address your specific concerns as they relate to the diet and related symptoms.You will be provided with resources, recipes, meal plans, shopping lists and strategies to help with the entire process. I am sharing everything I have learnt with you.It will not cover 1:1 consultations required to address your other health complaints or more detailed assessment if anything unexpected arises.Cost: For 10 weeks I will be running a 2 hour session to support you every step of the way.As this is our first time running the program, I have allocated the money that Narayani Wellness tithes (yes, we normally tithe 5% profits to charity) to subsidise this.The out of pocket fee is $50 each session, totalling $500 for the 10 week program. This will need to be paid up front to confirm your position.Interested? We have two positions left to fill so get in touch with us by this Friday 5th May to let us know your interested. Lucy or Rachel will schedule a call with me so we can have a chat about your suitability.

For years you have been suffering from Irritable Bowel Syndrome (IBS). You may have experienced abdominal pain, discomfort and bloating, frustrating bowel motions and reactions to ‘healthy’ food. You have tried diets, supplements and medications yet you are still suffering. How frustrating!!

But perhaps there is something else going on.

In our experience, many of our patients don't just have IBS but actually have Small Intestinal Bacterial Overgrowth (SIBO), which can be tested for and treated. Symptoms of SIBO are similar to symptoms of IBS, which is why it may have been overlooked (1).

SIBO explained

SIBO occurs when there is an increased number of bacteria in your small intestine (1). Having an increased bacterial load can cause havoc to your gut wall and can lead to trouble with digestion, poor nutrient absorption, immune dysfunction and reactions to food (2). SIBO left untreated has also been linked to nutrient deficiencies, depression, anxiety (3), fibromyalgia (4), hypothyroidism (5) and rosacea (6).

How did I get this?

The risk factors for developing SIBO are far and wide and are commonplace in today’s society. They include low stomach acid, which can naturally happens as we get older or through nutrient deficiencies that may occur if you have an underlying gut issue, chronic illness or poor diet. You also increase your risk of developing SIBO if you have used antibiotics or the oral contraceptive pill, if you drink alcohol or experience stress (1).

Can you relate to one or two of these?

How can I find out if I have SIBO?

In clinic, I regularly hear patients say things like ‘after a meal I look and feel four months pregnant’ or ‘I react to so many foods’. These statements make me consider SIBO as part of the their problem. The SIBO test is wonderful as it identifies its presence and helps us choose the most appropriate treatment for you. It is a test that can be performed at home or in a laboratory. After drinking a sugar, the breath test measures hydrogen gas and methane gas when you exhale, which indicates if SIBO is present, the type you have (methane dominant or hydrogen dominant) and how severe SIBO is for you.

To get SIBO under control we use a gentle combination of herbal, nutritional and dietary interventions. We follow a principle of 'do no harm' and we make sure we are supporting you and any the good bugs that are already in your gut. In addition we address risk factors that caused your SIBO to give you the best chance of it never returning and to live a life free of digestive distress.

If this sounds like something you or someone you know has experienced, it's time to take the next step forward to get you back to good health.

Leaky gut, also known as increased intestinal permeability, is linked to a whole bunch of common health complaints that we tend to just put up with or accept as being normal for my body. It has been linked to food intolerance's, acne and skin conditions, allergies and hay fever, asthma, fatigue and thyroid conditions. In addition to this, it can be associated with digestive symptoms such as constipation, diarrhoea and irritable bowel syndrome(1). Clearly, it is very possible that you, or someone close to you, is suffering from leaky gut.

How is this possible?

To understand how leaky gut may be at the root of your symptoms, you need to know a bit about the gut. Our gut has many roles including digestion and nutrient absorption, and is an important protective barrier that monitors our internal and external environment. It also plays a massive part in the function of our immune system. For example, did you know that about 75% of our immune cells live there(2)? It also has an intimate relationship with our nervous system. Have your ever noticed that when you feel stressed or anxious, you may experience a change in bowel movements? Nervous tummy anyone?

Why do we get leaky gut?

In a healthy gut, our gut wall cells are triggered to open up and absorb good things like nutrients and keep our bad bugs and toxins out. Our digestive system is always getting triggered to open up and close but can usually keep a happy balance and recover from any minor insults. When the gut is in contact with nasty triggers like medications, parasites, chemicals and certain foods, it’s ability to close up starts to struggle. If exposure is for a short time, the barrier can return to normal, however if these stressors continue, this barrier is strained. Then the immune system, which lies beneath the gut lining, becomes overwhelmed. It loses sense of what is self and what is a potential allergen, toxin or baddie. This dysfunction starts to cause trouble to the point of developing autoimmune conditions. Remember all the conditions mentioned at the start? Yes, the gut connection is real(3)!

What can I do about leaky gut?

Gut health and gut healing can be a tricky, especially if other conditions are present. A great place start would be:

1. Probiotics

Probiotics help with leaky gut because of their beneficial role in supporting the immune system in the gut wall. This is evidence of their support in a vast array of health conditions. It’s so important to understand that not all probiotics are the same and this is where clinical expertise can really help. If you react to fermented foods (a good source of probiotics) or probiotic supplements something else maybe going on including histamine intolerance. This is why it is helpful to work with someone experienced in treating gut issues(4).

2. High fibre foods

After putting in all the good bugs into our system, we need to feed them. High fibre foods really means a vegetable rich diet. Great fermentable foods include sweet potato, lentils, pumpkin leek, garlic, asparagus, onion. Think high FODMAP foods. Delicious(5)!

3. Reduce aggravating factors

We don’t want to keep giving our gut triggers that upset inflammation and immune function. Our body needs the time and environment to heal. This means limit alcohol, gluten, eat organic where possible and get rid of refined carbohydrates and sugar… put down the donut(6)!

4. Manage stress – yes this can be the hardest thing to do.

We live a lifestyle that fuels the fight and flight response and neglects our rest and digest nervous system – which is hugely important for our digestive ability. Ever experience diarrhoea when you feel anxious or constipation when feeling stressed? Whether it is journalling, deep breathing, yoga or walking, it is important to find a way to manage your emotional and mental health(7).

5. Eat a colourful, nutrient rich diet.

For our body to function at its best, it needs good sources of nutrients from a wide range of fresh, unprocessed foods. Fill your diet with good quality protein sources, a colourful variety of vegetables and fruits and you are on your way from getting all the nutrients and antioxidants you need for a healthy gut. We give a special shout out to amino acids like glutamine and nutrients like zinc and vitamin A, which the gut just loves.

How can I find out if I have leaky gut?

If you or someone you know suffer from the above mentioned conditions, then you should be considering the health of your gut and determining if you have leaky gut. As a practitioner who just loves all things gut health related, one of the first steps I take with my patients is testing for leaky gut. My inner nerd is thrilled by this test as it a brilliant way to measure how much healing needs to be done and can be tested again to assess progress. Once we identify if you have leaky gut, it is important to determine how to treat it holistically. Not only can you experience a positive shift in your current symptoms, but also prevent complications such as autoimmunity and chronic disease in the future. Isn’t that great?

If you are interested in finding out more about this or would like to be assessed, please get in touch. Let's get to the bottom of this!